Provider Demographics
NPI:1114905759
Name:CHEST INFECTIOUS DISEASES AND CRITICAL CARE ASSOCIATES P C
Entity Type:Organization
Organization Name:CHEST INFECTIOUS DISEASES AND CRITICAL CARE ASSOCIATES P C
Other - Org Name:CIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:WITTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-224-1777
Mailing Address - Street 1:1601 NW 114TH ST
Mailing Address - Street 2:STE 347
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7046
Mailing Address - Country:US
Mailing Address - Phone:515-224-1777
Mailing Address - Fax:515-225-6750
Practice Address - Street 1:1601 NW 114TH ST
Practice Address - Street 2:STE 347
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50325-7046
Practice Address - Country:US
Practice Address - Phone:515-224-1777
Practice Address - Fax:515-225-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15616OtherWELLMARK
IA015616Medicaid
IA015616Medicaid